Effect of Dexmedetomidine on Intestinal Barrier in Patients Undergoing Gastrointestinal Surgery - A Single-Centre Randomized Clinical Trial

Abstract

Background: Gastrointestinal failure accounts for death in critically ill patients. This study aimed to explore the effect and mechanism of dexmedetomidine (DEX) in intestinal barrier function in critically ill patients undergoing gastrointestinal surgery.Methods: Patients undergoing gastrointestinal surgery were randomized into a DEX group (n=21) or an MID group (n=21). Sufentanil was used in both groups for analgesia. In the DEX group, DEX was loaded (1 µg/kg) before sedation and was infused (0.7 µg/kg/h) during sedation. The mean arterial pressure (MAP), heart rate (HR), borborygmus resumption time (BRT), first defecation time (FDT), stay of ICU and hospital were observed. The DAO, D-LAC, TNF-α, IL-6 and α7nAChR levels in plasma or haemocytes were detected before the start of the sedation (0 h) and after the sedation (24 h).Results: There were no significant differences in age, sex, BMI, APACHE II score, SOFA (P>0.05). The MAP between 0 and 24 h presented no significant difference between the groups (P > 0.05), but HR was significantly slower in the DEX group (P=0.042). The recovery time of bowel sounds was significantly earlier in the DEX group (P=0.034). Both of the stay of ICU (P=0.016) and hospital (P=0.031) were significantly shorter in the DEX group. The expression of α7nAChR in the DEX group was significantly higher at 24 h than at 0 h (P=0.002). The D-LAC decreased significantly in the DEX group than MID group at 24 h (P=0.016).Conclusions: DEX maintained the integrity of the intestinal barrier in patients undergoing gastrointestinal surgery through the cholinergic anti-inflammatory pathway.Trial registration:ChiCTR1900024367. Registered 7 July 2019-Retrospectively registered, http://www.chictr.org.cn/showproj.aspx?proj=40832

Present and Future Therapeutic Approaches to Barrier Dysfunction

“…In another randomized, double-blinded prospective study, DMM enhanced the recovery of GI and reduced intestinal injuries and permeability, reflected by decreased serum diamine oxidase and intestinal fatty acidbinding protein expression (317). A recent randomized doubleblinded prospective study, suggests DMM as a more suitable anesthetic for patients undergoing GI surgery as it is associated with a decrease in TNF-α, and D-Lactate along with an increase in the activation of α7nAChR (318).…”